Journal of Bronchology & Interventional Pulmonology最新文献

Artificial intelligence (AI) is revolutionizing interventional pulmonology (IP) by enhancing diagnostics, procedural precision, and patient outcomes. AI-powered tools improve lung nodule detection, radiomics-based risk stratification, and bronchoscopic navigation. Machine learning (ML) algorithms aid in lung cancer screening by analyzing imaging data, reducing false positives, and improving early diagnosis. AI-driven robotic-assisted bronchoscopy enhances navigation and biopsy accuracy, particularly for peripheral lung lesions. Endobronchial ultrasound (EBUS) and cytopathology benefit from AI's ability to assess lymph node malignancy and optimize rapid on-site evaluation (ROSE). AI applications extend to phenotyping chronic obstructive pulmonary disease (COPD) and identifying candidates for bronchoscopic lung volume reduction (BLVR). Deep learning (DL) models analyze computed tomography (CT) imaging and spirometry data to optimize patient selection. AI-driven algorithms are also advancing pleural effusion detection, differentiation, and classification, supporting clinical decision-making. Education and research in IP are also transforming with AI-driven simulation, virtual reality, and automated assessment tools that enhance procedural training and competency evaluation. The integration of AI into clinical work and procedural training accelerates advancements while presenting challenges in ethical AI implementation, data security, and bias mitigation. As AI continues to evolve, its role in IP will expand, improving procedural efficiency, personalizing treatment plans, and optimizing patient selection for interventions. Future developments will focus on refining AI-driven predictive analytics, enhancing robotic-assisted procedures, and integrating AI seamlessly into clinical workflows. The responsible implementation of AI in IP holds the potential to transform patient care, reduce complications, and advance precision medicine.

Background: Reusable flexible bronchoscopes (RFB) and single-use flexible bronchoscopes (SUFB) are clinically equivalent. Economic evaluations are essential due to rising health care costs. This study aims to compare the costs of the procedure with RFBs or SUFBs, considering major factors such as procedure volume, fleet size, and SUFB model.

Methods: This single-center, observational study at Rouen University Hospital evaluated RFB costs (equipment, maintenance, and reprocessing) and SUFB costs (purchase and disposal). A micro-costing approach was used to estimate costs, with sensitivity analyses examining the impact of procedure volume and fleet size on costs.

Results: The total cost per procedure with RFBs was €195.72 in the endoscopy room and €231.48 in the operating room. The median cost for SUFBs was €245 (range: €208 to 336, depending on the model). RFBs became cost-effective over SUFBs if at least 913 bronchoscopies are performed annually. This threshold varies according to the RFB fleet, and the SUFB model.

Conclusion: This study highlights that RFBs are more cost-effective than SUFBs in high-volume settings. Therefore, the choice between RFBs and SUFBs should consider the facility's specific conditions, such as procedure volume and available equipment. A hybrid approach, using both devices, may be beneficial in settings with varying procedural demands.

Background: To evaluate the diagnostic performance of blood-based assays for distinguishing malignant from benign indeterminate pulmonary nodules.

Methods: We performed a systematic review and meta-analysis of prospective and retrospective studies assessing blood-based biomarker tests in patients with indeterminate pulmonary nodules (6 to 30 mm). Thirteen studies (n=2771 patients) met inclusion criteria, spanning proteomic assays, circulating cell-free DNA fragmentomics, and integrated clinical-biomarker models. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were estimated using random-effects models. Subgroup analyses, QUADAS-2 risk of bias assessment, and publication bias testing were conducted.

Results: Across all studies, the pooled sensitivity was 84.6% and specificity was 65.3%, with a summary AUC of 0.78. At a modeled 15% prevalence, the negative predictive value was 96%, supporting clinical utility for ruling out malignancy. cfDNA fragmentomics assays demonstrated the highest accuracy (AUC: 0.87) with consistent performance even in small nodules and ground-glass opacities, and across smokers and never-smokers. Proteomic assays showed greater variability, while integrated models performed with high sensitivity but modest specificity. Risk of bias was generally low, though heterogeneity was moderate. No evidence of publication bias was detected.

Conclusion: Blood-based biomarker assays show promise as adjunctive tools for pulmonary nodule management, particularly for excluding malignancy and potentially reducing unnecessary invasive procedures. Fragmentomics platforms demonstrated the most consistent performance, but further large-scale prospective studies are needed to address outstanding questions as clinical applications expand.

Background: Lung cancer remains a predominant cause of cancer-related deaths worldwide, and there are notable geographic and institutional differences in both diagnostic and staging approaches. To address this, the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary committee to craft evidence-based and evidence-informed recommendations for diagnosing peripheral pulmonary nodules and performing convex probe endobronchial ultrasound (CP-EBUS)-guided mediastinal staging.

Methods: A modified Delphi method guided the creation and refinement of 9 Population, Intervention, Comparator, Outcome (PICO) questions. A systematic literature review, updated through March 2023, served as the basis for drafting recommendations. The panel used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence and relied on National Institute for Health and Care Excellence (NICE) language to express the strength of each recommendation. Where suitable, meta-analyses were completed; otherwise, systematic reviews and consensus among experts provided the evidence for guidance.

Results: Nine recommendations were ultimately proposed: 6 were supported by meta-analyses and 3 by systematic reviews. The topics include comparing diagnostic yield and complication rates between peripheral bronchoscopy and transthoracic needle biopsy, the use of multiple biopsy instruments and the role of rapid on-site evaluation (ROSE) during peripheral bronchoscopy, and best practices for CP-EBUS-guided mediastinal staging. Several critical considerations emerged, such as lesion size, evolving technologies in bronchoscopy, and the importance of both available resources and local expertise.

Conclusion: These guidelines aim to standardize and streamline recommendations for the bronchoscopic diagnosis and staging of lung cancer. Since rapid technological progress and observational data play significant roles in this field, ongoing research and evidence updates will be vital to refining best practices. Clinicians are advised to tailor these recommendations according to local circumstances, the unique needs of their patients, and any new findings as they develop.

Background: Robotic navigation bronchoscopy (RNB) is effective for accessing peripheral lung lesions with precision and safety. However, the incidence of atelectasis during RNB can impede lesion identification. Higher positive end-expiratory pressure (PEEP) levels may mitigate atelectasis, but bedside assessment is challenging. Transpulmonary pressure (Ptp) assessment, proven useful in optimizing PEEP in ARDS, remains unexplored in RNB.

Methods: This single-center, prospective study enrolled 21 consecutive patients undergoing RNB. All patients were paralyzed and ventilated equally, including PEEP 10 cmH2O and Vt 6 to 8 cc/kg of ideal body weight, and had an esophageal balloon placed using established techniques. Once an adequate esophageal pressure (Pes) waveform was identified, the Pes was recorded. We used Pes as a surrogate for intrathoracic pressure to calculate Ptp.

Results: A total of 21 patients were enrolled (male 11, 52%), BMI (27±4.1). The mean nodule size was 26.83±9.33 mm. The diagnostic yield was 87% for malignancy. The mean Vt was 7.15±1.16 cc/kg. Mean Pes and Ptp were 9.64±3.76 cmH2O and 0.36±1.2 cmH2O, respectively. Eight patients had negative Ptp, and compared with patients with positive Ptp, there were more eccentric or no signals (75% vs. 45%) by rEBUS.

Conclusion: This study provides detailed instructions and feasibility of assessing Ptp in patients undergoing RNB and highlights a potential relationship between negative Ptp and the ability to obtain a concentric rEBUS signal. Our findings suggest that negative Ptp may be associated with a higher likelihood of encountering eccentric or absent rEBUS signals. Further research could enhance our understanding of pulmonary physiology during RNB.

Background: Electromagnetic navigation bronchoscopy (ENB) is an established modality for performing bronchoscopic biopsies of peripheral pulmonary lesions (PPLs). Although prior versions have been limited by computed tomography (CT) to body divergence (CTBD), the advent of digital fluoroscopic tomosynthesis with continuous real-time guidance with the Illumisite system may help to overcome CTBD. This enhanced visualization, however, will require additional radiation exposure to perform the 50-degree fluoroscopic sweep around the PPL, but data are lacking on the additional amount. The primary objective of our study is to evaluate the effective dose patients are exposed to during biopsy with this system.

Methods: Single center retrospective analysis evaluating demographic data, nodule size, nodule location, diagnostic yield, incidence of complications, and radiation exposure.

Results: Eighty-two patients underwent PPL biopsy from March 2021 to March 2023. The mean PPL size was 2.3±0.9 cm (0.9 to 4.9 cm) and 84% (n=69) were solid. The majority were in the peripheral lung third (53, 64.6%) and 71% (n=58) had an air bronchogram on CT chest. The mean fluoroscopy time was 5 minutes 10 seconds (± 3 min 39 s). The mean fluoroscopy cumulative air kerma (CAK) was 0.071 Gy (± 0.045 Gy) with a calculated mean effective dose of 0.997 mSv (± 0.63 mSv). The diagnostic yield was 73% (60/82). Pneumothorax occurred in 4 (5%) patients, all of which required chest tube drainage.

Conclusion: Radiation exposure with the Illumisite system was less than historical reports for CT-guided biopsy or cone beam CT-guided bronchoscopic biopsies. Diagnostic yield and incidence of complications were comparable to prior reports.